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General NPI Number Information
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NPI Number | 1669514840
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Entity Type | Individual
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Provider Name | BRENDON M. COUGHTRY M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 99 WELLPARK LANE STE 4
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City | CAMPBELLSVILLE
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State | KY
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Zip | 42718-4919
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Country | US
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Telephone | 606-260-8613
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Fax | 859-977-2683
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Provider Business Mailing Address
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Address Line | PO BOX 21890
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City | BELFAST
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State | ME
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Zip | 04915-4115
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Country | US
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Telephone | 502-907-0356
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Fax | 502-919-9780
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 42072
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License Number State | KY
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